Suicide and High Risk Groups

Suicide in Canada, as in most countries, is a gendered phenomenon. 74.6% of all suicides decedents are men. In 2011, suicide among men of all ages in Canada ranked as the seventh leading cause of death (Statistics Canada; http://www.statcan.gc.ca/tables-tableaux/sum-som/l01/cst01/hlth36b-eng.htm). The increased risk of death by suicide among Canadian men is especially pronounced in the age range of 40‐50, when male suicide rises to a peak before gradually falling and then rising once more past the age of 80. More middle-aged Canadian men died by suicide in 2011 (N =1366) than by motor vehicle accidents, homicide, and HIV combined (N = 803). Middle-aged men account for a disproportionate number of Canadian men who die by suicide. Forty-nine percent (49.1%) of the Canadian male suicide decedents were between the ages of 40 to 64 (Stats Canada 2011).

Suicide among middle-aged men can be described as a “hidden epidemic.” Historically, younger men were at greater risk than older ones, but this has changed in recent decades. There had been a noticeable change in suicide patterns in recent years with men in the “prime of life” (i.e., the peak of one’s power and vigor) now the biggest area of concern. (O’Connor,http://www.telegraph.co.uk/news/uknews/10647018/Suicide-generation-fears-for-middle-aged-men.html). Middle-age for men appears to be a risk factor for suicidal behaviour. Research has shown that middle-aged men, particularly men in the lower socio-economic strata, experience the lowest levels of well-being and the highest suicide rates (Kreitman eta la., 1991; Tomlinson, 2012). Yet despite the significant contribution to men’s mortality, the climbing rates of suicides among middle-aged men are absent from public discourse on men’ health; it is rarely discussed as a social phenomenon nor as an urgent public health problem. In the past, suicide prevention efforts have focused most heavily on groups that are considered to be most at risk, such as teens and young adults of both genders as well as elderly men, whose rates of suicide have historically been the highest in Canada. Research and resources dedicated to these subgroups have increased the public awareness and the identification of suicide in these populations. Since middle-aged men have been effectively excluded from suicide prevention, awareness and screening programs, they have become uninformed about suicide risk factors, prevention programs and interventions, which in turn has led to the relative increase in the suicide rate. Despite the significant impact of suicide on men’s mortality and paralleling the absence of suicide prevention activities and resources targeting middle-aged men, there is a lack of research exploring the unique risk factors, causes, and prevention of suicide germane to men in mid-life.

Mid-life

Introspection and self-assessment are integral psychological aspects of mid-life, which involve the examination of one’s life and position in the social environment vis-à-vis work/career, family, and social relationships (Neugarten, 1968; Tamir, 1982). Men in mid-life experience significant heightened awareness of self and tend to introspectively assess their lifetime roles, challenges, and achievements. The “prime-of life” for men is characterized by a sag in their sense of well-being (Blanchflower & Oswald, 2007). Well-being is altered as lives are evaluated at a conscious and subconscious level. Clinical studies also reveal that the middle-aged section of the population has a significant increase in mental health problems, including depression, alcoholism, and suicide (Boyd & Wasserman, XX)

Masculinities

There is a growing recognition that the social construction of masculinity is a major factor that tends to impede positive physical and mental health outcomes for men (Courtenay, 2000). Masculinity is a social construction that is specifically related to an historical time, culture, and locale (Connell, 1995; 2005). There is no singular form of masculinity but rather a multiplicity and diversity of masculinities which are dynamic and are continuously being constructed and deconstructed in response to life events, age, social context, class, ethnicity and life experiences (Connell, 1995; 2005). “Hegemonic masculinity” refers to the current form of masculinity to which most men aspire and/or against which they measure themselves in relation to femininity and other masculinities which are marginalized and subordinated. Marginalized masculinity refers to gender relations experienced by men in lower socio-economic strata.

Men’s health risks are shaped, in part, by social norms and cultural expectations of masculinity. Decreased help-seeking and a higher engagement in risk behaviour are two crucial health-damaging manifestations of traditional masculinity values (Connell, & Messerschmidt, 2005). Specific behaviours associated with traditional forms of masculinity are likely to be hazardous to men’s health to the point of propelling men toward suicidal behaviour (Samaritans, 2012; Courtenay, 2000; Smith, Braunack-Mayer, & Wittert, 2006; Synnott, 2010).

Traditional masculinity endorses and fosters emotional control and power. Depression, conversely, is often associated with a sense of powerlessness and a lack of control over emotions. Men are reluctant to express emotions and they may conceal or deny distress and emotional pain, thereby not seeking the help they need. Some men conceptualized suicide as a mean of regaining ‘control’ when confronted with depression. Houle, Mishara and Chagnon (2008) found that adherence to the traditional masculine gender role differentiated men who attempted suicide from those who experienced similar stressful events but who had no history of suicidal behaviour.

Masculinity and Identity, Employment, Marriage, and Coping Skills

Middle-aged men are impacted by socio-economic and cultural changes and transformations, which influence and shape their identities, experiences, relationships and emotions. These transformations also contribute to the context of suicidal behaviour in middle-aged men. There is incongruence between the imposed traditional masculinity gender role and the reality of everyday life. Society has moved on but middle aged men are not as prepared as they should be to deal with the changes in their role in society. Men in mid-life are now part of the ‘buffer’ generation caught between two generations – the prewar ‘silent’ and the post-war ‘me’ generation- not sure whether to emulate their older, more traditional, strong, silent, stoic fathers or be like the younger, more progressive, open, and individualistic generation of their sons (Platt, Samaritans Report, 2012). As a result, they may feel trapped and one way of reclaiming their own masculinity is to take one’s own life.

Middle-aged men are achievement-oriented and are defined by paid work, physical strength, status, competitiveness, stoicism, being in control, success and power. They compare themselves against a ‘gold standard’ which prizes power, control and invincibility. Work defines their status in the masculine hierarchy and the workplace is the social realm within which masculinity is practiced and reconstructed in interaction with other men (Lee & Owens, 2002; Riska, 2002).

With the shift towards a more service-oriented economy and the decline in traditional male industries, particularly in communities once dependent on male dominated industries, not only do middle-aged men end up losing their jobs, but they lose workplaces that allow for the expression working-class masculinity, a primary source of valued masculine pride and identity (Samaritans, 2012).

Being unemployed in mid-life could be extremely distressing as it challenges men’s own expectations of stability and security. Regardless of the socioeconomic status, there is still considerable social pressure on men to conform to the masculine husband role. Middle-aged men may conceive of unemployment as a double failure given that they are unable to meet two key demands of the masculine role: being employed and ‘providing’ for the family. Middle-aged men who are unemployed or experiencing financial difficulties may be at greater risk of depression and other mental health problems, relationship breakdown, social isolation, alcohol and drug use, and suicide.

Mid-life is a significant risk factor for separated or divorced men. Several studies found that relational breakdown is associated with heightened suicide risk for both men and women. Research has shown that marriage or a stable relationship is conversely a protective factor against suicide. Marriage enhances well-being, reduces exposure to stress, provides meaning and social norms, and increases access to social networks (Evans, Scourfield, Moore, 2012). Several explanations are offered for the differential impact of relational breakdown. Within Western society there is a strong cultural emphasis on achieving a strong and happy marriage (Kposowa, 2000). Marriage is associated with a wide range of health gains for men and women, however, health risks of being unmarried are greater for men (Courtenay, 2011). Divorced/separated men seem particularly vulnerable to suicidal “ideation” (thoughts and planning) and to suicide.

Marriage lowers suicide acceptability more for men than for women (Stack S, 1998). It enhances wellbeing, lessens the exposure to stress, provides a source of social norms and meaning, and increasing access to social networks. Men derive more physical and mental health benefits from marriage than do women, thus the breakdown of a marriage could lead to more detrimental outcomes for men. There is a significant difference in the way women and men initiate and maintain supportive social networks. Men in mid-life remain overwhelmingly dependent on a female partner for emotional support. Middle-aged men who endorse traditional masculine gender role that include attributes of independence and control are less likely to have large, supportive social networks. For these men, marriage acts as an important protective factor, as it provides them with an important source of stability and emotional support. Because they are less socially connected to supportive networks than women, men are more vulnerable to suicide after the break-up of a marriage (Burr et al., 1997).Divorce increases the risk of suicide because men are more likely to be displaced from the family home, and to be separated and from their children. Separation from children appears to be a significant suicide risk factor for some men (Evans, Scourfield, & Moore, 2012).

Masculinity norms deter disclosing emotional vulnerability and distress. Middle-aged men who experience high levels of emotional distress may have difficulties identifying symptoms and often use maladaptive coping mechanisms such as self-medicating with alcohol and drugs, which exacerbate and prolong the emotional distress. Substance use also is considered to be a ‘masculine’ way of coping. Over time this may lead to a situation where men feel that their options are limited, and thus opt for suicide rather than disclose distress and seek help (Cleary, 2011). Excessive alcohol and drugs is also associated with increased impulsivity and reduce inhibitions, resulting in an increased likelihood of suicidal behaviour at a time of crisis.

Youth

In Canada in 2009, suicide was the second leading cause of death among individuals aged 15-34 years, second only to accidents/unintentional injuries. The loss of young, potentially productive people from society has been estimated by the WHO in terms of disability-adjusted life years, which indicates the number of healthy years of life lost to an illness or event.

In the year 2011 suicide was reported as the cause of death for:

29 individuals aged 10-14;

198 suicides for youth aged 15-19;

301 suicides for youth aged 20-24.

It should be noted that some youth populations have significantly higher rates and risk of suicide. In particular, there is concern for youth who identify as LGBT, or youth that are First Nations, Inuit or Metis.

Suicide among youth in some First Nations, Inuit and Metis communities is exponentially higher than non-Native youth. For example, male Inuit Native youth are 11 times more likely to die by suicide than a non-Inuit youth male. It is important to note that high rates of youth suicide do not occur in all First Nations, Inuit or Metis communities.

For more information specific to LGBT Youth Suicide I would encourage you to look at the website and good work of Egale Canada. Specifically, their Suicide Prevention efforts which are outlined here . http://egale.ca/category/youth-and-safer-schools/suicide-prevention/